Adolescents with insulin-dependent diabetes mellitus (IDDM) are challenged to adapt to a lifetime of daily therapeutic management of their illness along with the uncertainty of a future with underlying biological complications. Dysautonomia is one such complication that leads to the development of many debilitating and life-threatening conditions that may ultimately compromise quality of life for these youth. However, when compromised autonomic function and quality of life is first manifest, it has to be clearly identified. Possible linkage among them can provide direction for developing age-appropriate interventions to avert both biological and psychological dysfunction. This award will allow the applicant to formulate a program of research to evaluate the outcomes of interventions over time and to acquire the knowledge and skills to strengthen an independent research trajectory focusing on the specific health needs of youth with diabetes. Close mentoring with the grant sponsor, an experienced nurse scientist in the areas of quality of life and automatic function research, will guide the career development phase of the award. Such mentorship along with involvement in collaborative work with an established clinical research team, additional statistical coursework, and conduct of the proposed research will result in the level of scholarship necessary for establishment of an independent program of research. The intent of the proposed study is to establish normative age-related indices for autonomic function, identify differences in quality of life and autonomic function in youth with and without IDDM, and explore the biobehavioral linkages between autonomic function and quality of life in youth with IDDM. Approximately 120 adolescents from 13 to 18 years of age with IDDM and a comparison group similar in age, gender, race, and body size will participate in the study. Quality of life will be evaluated by both the adolescents and a respective parent or legal guardian. Quality of life measures include the Diabetes Quality of Life Measure for Youth, the Self-Perception Profile for Adolescents, the Child Behavior Checklist, and Functional Status II. Autonomic testing for both adolescents with and without IDDM will measure vasomotor, cardiac, and gastric function using advanced technologies such as infrared photoplethysmography and power spectral analysis. Factors which may contribute to perceptions of quality of life or autonomic function will also be measured. These include age, gender, race, age of onset, duration of IDDM. Tanner's stage of sexual development, and metabolic control. Statistical analyses will assess the reliability of autonomic function testing and establish normal ranges of controls as a means of comparison to youth with IDDM. Differences between the groups and biobehavioral linkages of quality of life and autonomic function will be explicated using analysis of variance and correlational procedures.